Male Factors of Infertility

Male Factors of Infertility require comprehensive consideration. We can focus on several categories for these causes.

Pre-testicular Disorders

Male factors – Disorders in this group are generally referred to as hormonal causes. The hypothalamus, located in the lower part of the brain, releases the GnRH hormone, which regulates the physiological functioning of the reproductive system. It acts on the pituitary gland, just below the hypothalamus, stimulating the release of FSH and LH hormones. These hormones are responsible for sperm production (FSH) and the secretion of testosterone, the male hormone (LH), respectively. Malfunctions in the release of these hormones can lead to infertility. Some examples of these disorders include Kallmann syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome, pituitary gland surgeries, pituitary gland tumors, atrophy due to impaired blood supply to the pituitary gland, radiation therapy, and infections.

Testicular Disorders

Causes related to sperm production disorders (non-obstructive). This problem occurs when the cells responsible for sperm production in the testes are unable to produce sperm due to various reasons. The main causes include hormonal disorders, chromosomal abnormalities, congenital absence of testes (anorchia), undescended testes (cryptorchidism), impaired testicular blood supply (testicular torsion), infections (orchitis), chemotherapy, environmental factors (radiation, high heat, lead, arsenic, cadmium, and other metals), and certain medications.

Sperms produced in the testes are transported to the penis through the epididymis and the vas deferens, which are the sperm-carrying channels. It is possible for the produced sperm cells to be unable to reach the ejaculate (semen) due to an obstruction in this system.

Congenital absence of vas deferens (unilateral or bilateral): This congenital disorder refers to the absence of the sperm-carrying channels called vas deferens, which transport sperm from the testes. It is often accompanied by the absence of a significant portion of the seminal vesicle and epididymis. Individuals with this condition may be carriers of a genetic disease called Cystic Fibrosis, with a prevalence of 50-80%.

Acquired canal obstructions: Infections (particularly gonorrhea, tuberculosis), trauma, previous surgical interventions on these organs or adjacent organs, presence of prostate or seminal vesicle cysts or stones, can lead to obstruction of the canal integrity, preventing the exit of sperm despite continued sperm production in the testes. Various surgical interventions (vasovasostomy, vasoepididymostomy, TURED surgeries) can be performed to remove the blockage. In cases where the canal is not developed congenitally, sperm can be extracted from the testes using a needle and couples can conceive through the method of microinjection.

Other causes can include diabetes, neurological disorders, damage to the lumbar spine due to trauma, retrograde ejaculation (ejaculate flowing backward into the bladder instead of out of the penis) following bladder or urethral surgeries, erectile dysfunction, congenital or acquired penile curvature (Peyronie’s disease) leading to the inability to engage in sexual intercourse, and the urethral opening being located on the shaft of the penis instead of the tip (hypospadias).

Click here for Female Factors of Infertility